Gender differences in social networks of women and men who inject drugs in Kenya.

BACKGROUND

Women who inject drugs (WWID) face heightened HCV and HIV risk compared to men (MWID); yet underlying differences in social and injection networks are not well understood, particularly in resource-limited countries.

METHODS

We enrolled 3152 people who inject drugs (PWID) in Kenya using respondent driven sampling. Participants were tested for HIV, HCV, and HBV, and completed a survey with behavioral and network questions. An individual's social network members (NMs) were defined as participants they had used any drugs with and knew by name. Bivariate analyses were conducted for associations between gender, network characteristics, and injection behaviors. Multivariate logistic regressions were conducted for both men and women to examine the associations between network characteristics and disease status.

RESULTS

About one-tenth of participants were women (9.7%, N= 306), 19.3% were HCV antibody-positive (N = 610), and 9.7% were HIV-positive (N = 306). Women were significantly more likely to be HCV antibody-positive (26.5% vs. 18.6%, p < 0.001) and HIV-positive (31.1% vs. 7.4%, p < 0.001) than men. Women were significantly more likely to have injected and had sex with people in their networks than men were (3.9% vs. 1.0%, p < 0.001). Knowledge (or lack thereof) of NM's HIV and HCV status had significant associations with HIV and HCV positivity for both women and men.

CONCLUSION

Women face differential HCV- and HIV-related risk in part based upon their relationships to and behaviors with their network members. Further research examining nuances of injection and sexual relationships among women and men who inject drugs is needed. Interventions accounting for gender-based risks should also be considered.